Minimal surgery for chronic obstruction in patients with extensive or universal Crohn's disease.

Patients with extensive chronic Crohn's disease of the small bowel, who may have had repeated excisional surgery, sometimes develop intestinal obstruction due to the development of a stricture. Surgery is usually thought to be contraindicated since further resections would leave the patient with insufficient small intestine to maintain a normal state of nutrition. Nine such patients have been treated since 1979 by operations which have been designed simply to relieve the obstruction. After careful preparation with intravenous alimentation, clearing the intestine of its contents, and the use of prophylactic antibodies the strictures were treated with minimal excisions, enteroenterostomies, and 'strictureplasties' according to their length and the degree of inflammation. In spite of the apparent danger of carrying out the operations through active Crohn's inflammation there have been no fatalities or major complications and the long-term results have been good.